Atlas of endoscopic anatomy for endonasal intracranial. The sublabial transsphenoidal approach for the removal of pituitary adenomas was the standard procedure 16, 17, 18, 24 for pituitary surgery until recently 1, 5. The posterior clinoid process pcp is an osseous structure located at the superolateral aspect of the dorsum sella. Cranial base, endoscope, endoscopic anatomy, skull base, suprasellar lesions, transsphenoidal surgery. There are specific technical considerations in children and adolescents who undergo an endonasal transsphenoidal procedure. A total of 1,166 pituitary adenoma patients that underwent pure endoscopic endonasal transsphenoidal surgery, conducted by the leading surgeon zhou tao at the neurosurgery department of pla general hospital between january 2007 and june 20, were retrospectively studied. Endoscopic approach for endonasal skull base surgery has undergone a remarkable evolution in the last two 1decades. In transnasal transsphenoidal endoscopic surgery, a surgical instrument is placed through the nostril and alongside the nasal septum to access a pituitary tumor. The radiologist requires a thorough knowledge of the normal anatomy and the pathological spectrum of this region. The introduction of the endoscope to transsphenoidal pituitary surgery is not new and it has been abandoned in the past. Recent evolution of endoscopic endonasal surgery for treatment of. Fully endoscopic transnasal transsphenoidal pituitary adenoma resection 18.
Craniopharyngioma endoscopic endonasal approach neurosurgery. Endoscopic endonasal transsphenoidal resection of pituitary. Urgent optic nerve decompression via and endoscopic endonasal transsphenoidal. The endoscopic endonasal transsphenoidal approach to pituitary tumors is a safe and minimally invasive procedure, which can be employed safely. The procedure is performed via an anterior sphenoidotomy.
Endoscopic endonasal transsphenoid surgery of pituitary adenoma. Intraoperative virtual endoscopy for image guided endonasal. Use of an endoscope in transsphenoidal approaches repre. Most of the reported symptomatic cases were managed by resection via craniotomy. Then you can start reading kindle books on your smartphone, tablet, or computer no kindle device. Introduction discussion therefore, after our extensive experience with over 250 patients treated by means of the endoscopic endonasal transsphenoidal approach for pathologies of the sellar region, we describe herein the characteristics of the proper. Endoscopic endonasal transsphenoidal approach for pituitary adenomas technical aspects and report of casuistic americo rubens leite dos santos1, roberto monteiro fonseca neto1, jose carlos esteves veiga1, jose viana jr. Imageguided endoscopic endonasal transsphenoidal surgery article pdf available in min minimally invasive neurosurgery 531. A neurosurgeon or an otolaryngologist, using an endoscope that is entered through the nose, fixes or removes brain defects or tumors in the anterior skull base.
Refinements in camera definition, surgical instrumentation, navigation, and surgical technique, including the dual surgeon team, have facilitated purely endonasal endoscopic approaches to the majority of the midline skull base that were previously difficult to access through. Microscopic endonasal transsphenoidal surgery in patients. This procedure introduces various advantages compared with the transsphenoidal microsurgical approach such as a wider vision of the surgical field, less traumatism of the nasal structures, greater facility in the. Endoscopic endonasal transsphenoidal surgery for sellar tumors in children. We report the experience of endoscopic endonasal transsphenoidal surgery eets for resection of pituitary region tumours at wellington, the central regional referral centre for neurosurgery in new zealand, and discuss the collaborative mentoring surgical model that enhanced the learning experience. Daniel kelly has one of the worlds largest endoscopic endonasal transsphenoidal surgery experiences with over 2000 patients treated, including over 800 fully endoscopic surgeries and an academic track record of over 50 publications related to endonasal surgery and pituitary hormonal disorders. Pdf endoscopic endonasal transsphenoidal approach to. Endoscopic endonasal transsphenoidal surgery neurosurgery. Endoscopic endonasal transsphenoidal approach to sellar. Endoscopic endonasal transsphenoidal resection of pituitary macroadenoma performed by james k.
Evolution of transsphenoidal surgery endoscope, endoscopic equipment and instrumentation endoscopic anatomy along the transnasal approach to the pituitary gland and the surrounding structures role of the endocrinologist role of the. However, over the years, skull base surgery has evolved from standard open craniotomies to the use of microscopes and, more recently, to the development of endoscopic techniques. Microscopic transsphenoidal surgery for pituitary adenomas in. The past two decades have been the setting for remarkable advancement in endonasal endoscopic neurosurgery.
Liu, md, director of the center for skull base and pituitary surgery at neurological institute of new jersey, and assistant professor of neurological surgery at the new jersey medical school, university of medicine and dentistry of new jersey umdnj. Endoscopic surgery is performed through the nose to remove tumors from the pituitary gland and skull base. The midline skull base is an anatomical area, which extends from the anterior limit of the anterior cranial fossa down to the anterior border of the foramen magnum. Dec 23, 2010 the authors investigate the complications of transnasal transsphenoidal endoscopic surgery in the treatment of 301 patients with pituitary adenomas. Ashish suri, department of neurosurgery, aiims,new delhi, india.
Extended skull base surgery based on endoscopic endonasal transsphenoidal surgery eetss for various skull base lesions has been reported recently. In comparison with open surgery, the endoscopic approach offers several advantages. The endoscopic endonasal transsphenoidal approach is a minimally invasive surgical technique for the removal of sellar and parasellar lesions. Currently, surgical management provides the definitive treatment of choice for most pituitary adenomas, craniopharyngiomas and meningiomas of the sellar region. Endoscopic endonasal approaches to the ventral skull base are categorized based on their orientation in coronal and sagittal planes. Since the first report of successful endonasal endoscopic resection of pituitary adenomas by jankowski et al 1 in 1992, endoscopic endonasal surgery has become the most popular choice of neurosurgeons and otolaryngologists to treat lesions of the skull base 26. Endoscopic endonasal surgery was first described in 1910 concurrently by harvey cushingand oskar hirsch. Endoscopic endonasal transsphenoidal surgery american. Microscopeguided endonasal transsphenoidal approach the. Endoscopic endonasal posterior clinoidectomy surgical. The outcome of endoscopic endonasal transsphenoidal surgery in 10 patients with pituitary adenomas was compared with that of traditional transnasal transsphenoidal approach tta in 20 subjects. The pure endonasal endoscopic surgery of pituitary tumors was developed by jho and carrau 7, 8. Acclaimed international experts bring you detailed guidance on natural history, radiologic and clinical aspects, surgical indications, and resection techniques.
The endonasal endoscopic approach for pituitary tumors is effective and has low morbidity. Endoscopic endonasal approach to foramen magnum meningioma. Instruments for endoscopic endonasal transsphenoidal surgery. Pdf anatomy and surgery of the endoscopic endonasal. Six months after surgery, the main complaints of sinonasal quality of life were negligible, and overall health status was near complete recovery to preoperative status. Following endoscopic endonasal surgery, patients spend on average of 2 to 5 days in the hospital. Keywords endoscopic surgery endonasal, transsphenoidal surgery pituitary adenoma pituitary tumors, one of the most frequent intracranial tumors, are clinically classi. Endoscopic transnasal transsphenoidal surgery mayo clinic. Endoscopic endonasal transsphenoidal approach springerlink.
Cappabianca has been a leader in this regard and has developed a set of instrumentation specific to this procedure. Endoscopic endonasal transsphenoidal surgery springerlink. Apr 01, 2004 of course, the art of surgery has evolved over time, from the early century exploits of cushing to promote transsphenoidal surgery, followed by a resurgence of transcranial procedures, which eventually gave way to a resurgence of the transsphenoidal approach with hardy and guiot. Endoscopic endonasal transsphenoidal approach for pituitary. Harvey cushing played an instrumental role in popularizing the endonasal route as it was pioneered by surgeons of his time, including schloffer and halstead. Oneandahalf nostril endoscopic transsphenoidal approach. No patient underwent otorhinolaryngological surgery after the hypophyseal intervention. Some surgeons still consider nasolabial approaches, 26,28,29,30 others use an endonasal microscopic approach, 27 and a third group of clinical researchers approach the region via an endonasal route under endoscopic view. Endoscopic endonasal transsphenoidal surgery of 1,166. The oneandahalf nostril endoscopic transsphenoidal approach for pituitary adenomas is a simple and reliable technique.
This study aimed to evaluate clinical outcomes after traditional microsurgeries or eeas for sbcs. Sep 14, 2014 stepbystep description endonasal endoscopic pituitary surgery by prof. Ecchordosis physaliphora ep is a benign notochordal remnant that is usually asymptomatic. Note the difference of viewing angle, which is much wider in the endoscopic technique.
For many lesions of this area, a variety of skull base approaches including anterior, anterolateral, and posterolateral routes, have been proposed over the last decades, either alone or in combination, often requiring extensive. The present study assesses endoscopic endonasal transsphenoidal surger y using neuronavigation for pituitar y adenoma. Postoperative complications according to the report, newonset hypona tremia is the most common postoperative complication. In the last 2 decades, endoscopic endonasal transsphenoidal surgery has become the most popular choice of neurosurgeons and otolaryngologists to treat lesions of the skull base, with minimal. Nov 15, 2016 other complaints were decreased significantly. Endoscopic endonasal craniopharyngioma surgery youtube. Aug 21, 2009 the aim of this study is to report the results of a consecutive series of patients undergoing pituitary surgery using a pure endoscopic endonasal approach and to evaluate the efficacy and safety of this procedure. Endoscopic pituitary surgery transsphenoidal overview.
Contains operative video viewer discretion advised. Endoscopic endonasal surgery is a minimally invasive technique used mainly in neurosurgery and otolaryngology. Here we describe the procedures of endoscopic pituitary and skull base surgery in our institute. In patients with small nostril, especially children, women, and asians, sufficient working space cannot. In this study, the pure endoscopic endonasal transsphenoidal surgery is the only operative method. Endoscopic pituitary and skull base surgery anatomy and surgery of.
With regard to the first point less room in which to work, ensuring a secure grip is necessary. Postoperative nasal packing was basically not needed in such cases. Microscopic endonasal transsphenoidal surgery in patients with small nostril 26 transsphenoidal operations, with approximately 300 cases recently approached through the endonasal route using a speculum under a microscope. In the last 2 decades, endoscopic endonasal transsphenoidal surgery has become the most popular choice of neurosurgeons and otolaryngologists to treat lesions of the skull base, with minimal invasiveness, lower incidence of complications, and lower morbidity and mortality rates compared with traditional approaches. Modern indications for endoscopic endonasal surgery. Transsphenoidal approach in endoscopic endonasal surgery for. If the suprasellar extension is very important, a fully endoscopic twostaged procedure may be performed, while waiting for the natural descent of the residue 8. Ebook endonasal endoscopic surgery of skull base tumors. Pediatric endonasal endoscopic skull base surgery a casebased manual 9 1 introduction endonasal skull base surgery has become widely accepted as a technique to manage adult skull base tumors, however, there has been limited work done in the pediatric population. The endoscopic technique has been gaining in popularity in recent years.
Endonasal endoscopic approach for transsphenoidal excision of pituitary adenoma is considered less invasive and less stressful to patients, with results comparable to the previous gold standard. Steps simulation of transsphenoidal endonasal pituitary surgery is a virtual endoscopy system designed to aid neurosurgeons as a training and planning device for endonasal transsphenoidal pituitary surgery. Liu, md, director of the center for skull base and pituitary surgery at neurological institute of new. Now, after some technological advances has been proposed again as an advancement in this field. Pickard jd, akalan n, di rocco c, dolenc vv, lobo antunes j, mooij jja, schramm j, sindou m eds advances and technical standards in neurosurgery. Endoscopic endonasal surgery ees has recently been introduced as a treatment option for both pediatric and adult craniopharyngiomas. Data were analyzed from 178 consecutive patients with pituitar y adenomas who under went endoscopic endonasal transsphenoidal surger y using neuronavigation between april 2007 and may 2014. Endoscopic endonasal transsphenoidal surgery for sellar. Surgical anatomy for extended endoscopic endonasal. A comparative study between traditional microscopic. Microscopic transsphenoidal surgery has long been considered the gold standard in surgical treatment of pituitary tumors. The transsphenoidal approach, which was known in 42 cases, was sublabial in 39 cases 92.
Mar 24, 2011 endoscopic endonasal transsphenoidal resection of pituitary macroadenoma performed by james k. The object of the present study was to present the results of ees and analyze outcome in both the pediatric and the adult age groups. It is invaluable for all otolaryngologists, head and neck surgeons, neurosurgeons, neuroradiologists, and pathologists who routinely make. Perioperative course of transsphenoidal pituitary surgery. Endonasal approach via the sphenoid ostium was carried out for pituitary lesions without the nasal speculum.
A case of ecchordosis physaliphora presenting with an. The expanding role of the endonasal endoscopic approach in. Endoscopic endonasal transsphenoidal surgery of 1,166 pituitary adenomas surgical endoscopy, oct 2014 fuyu wang, tao zhou, shaobo wei, xianghui meng, jiashu zhang, yuanzheng hou. Virtual endoscopy for preoperative planning and training of. Transsphenoidal approach in endoscopic endonasal surgery. Endoscopic endonasal transsphenoidal surgery book, 2003. Steps allows the user to obtain simulated endoscopic images of anatomy of interest.
Endoscopic endonasal transsphenoidal surgery ebook, 2003. Comparison of endonasal endoscopic surgery and sublabial. In this multiauthor book with numerous color illustrations the main aspects of the endonasal endoscopic approach to the skull base are presented, starting with a clear description of the endoscopic anatomy, the panoramic view afforded by. Firstly, it is valuable for the education of residents and staff as they can follow the procedures in realtime on screens. The progress of endoscopic techniques for paranasal sinuses surgery 5 revealed the opportunity for an endoscopic pituitary gland. However, there is still a debate on this topic and some authors consider endoscopic surgery a form of developing surgery in an evolution step.
Endonasal endoscopic transsphenoidal approach to lesions of. In this multiauthor book with numerous color illustrations the main aspects of the endonasal endoscopic approach to the skull base are presented, starting with a clear description of the endoscopic anatomy, the panoramic view afforded by the endoscope and the development of effective instruments and adjuncts. Endoscopic endonasal surgery for craniopharyngiomas. A 4 mm highdefinition endoscope is in the right nostril providing visualization and two working instruments are in the right and left nostrils.
For all of these approaches, the sphenoid sinus is the starting point, and provides orientation to important vascular and neural structures. Postoperatively, all patients who had undergone endonasal endoscopic surgery had unobstructed nasal airways. This procedure allows access to the sellar space, or sella turcica the surgeon starts with the transnasal approach prior to using the transsphenoidal approach. Transsphenoidal surgery is the mainstay of treatment for most kinds of pituitary adenomas and other sellar masses. A retrospective analysis of complications in 301 patients submitted to transsphenoidal transnasal endoscopic surgery at the general hospital of fortaleza, brazil between january 1998 and december 2009. The endoscopic endonasal approach eea permits a direct extradural route without brain retraction and shorter postoperative recovery. The elegant minimally invasive transnasal endoscopic approach to the sella turcica and the anterior skull base has added a new dimension of versatility to pituitary surgery and can be adapted to many lesions. Although sbcs have traditionally been resected by craniotomy or microscopic transsphenoidal surgery tss, the recent development of the endoscopic endonasal approach eea has revolutionized treatment strategies through minimally invasive techniques. The 177 enrolled patients underwent fully endoscopic transsphenoidal surgery. We report a case of a 20yearold male presenting with abducens nerve palsy. Anatomy and surgery of the endoscopic endonasal approach pdf. It is only recently that the use of the endoscope as the sole visualizing tool has been introduced in transsphenoidal pituitary surgery with its favorable related implications and minimal operative trauma. Endoscopic endonasal transsphenoidal treatment for acromegaly. Endoscopic endonasal transsphenoidal surgery request pdf.
Endoscopic endonasal surgery for petrous apex lesions. With these advances, the need for more robust skull base reconstructive techniques was vital 1 since 1995 there is a remarkable advancement in endonasal. Cureus endoscopic endonasal transsphenoidal treatment of. Among the 19 patients with nonsecreting adenomas, 16 underwent total resection and three subtotal resection leaving residual tumor in the cavernous sinus. Daniel kelly, director of the pacific pituitary disorders center discusses an endoscopic endonasal approach to resect a suprasellar craniopharyngioma, causing hormonal dysfunction and headaches. Secondly, endoscopic surgery causes no facial incision, scars, or facial swelling. We report our experience of treating pituitary apoplexy using an eea approach. Oronasal complications in patients after transsphenoidal. Normally an otolaryngologist performs the initial stage of surgery through the nasal cavity and sphenoid.
Endonasal endoscopic pituitary and skullbase surgery. Subtotal removal str was achieved in 53% of craniotomy, 43% of transoral approach toa, 17% of transsphenoidal surgery tss, 20% of eea, and 100% of staged surgery cases p 0. The interval between surgery or in transsphenoidal reoperation cases of the last surgery and the rhinological examination ranged from 7 months to 24. Pituitary apoplexy is a rare clinical entity and few cases treated with an endonasal endoscopic approach eea have been reported. The radiology of endoscopic endonasal transsphenoidal. Endoscopic endonasal approach for pituitary adenoma. Schwartz t h, aa endoscopic extended of of technique. Gross total removal gtr was achieved in 1 case with the endoscopic endonasal approach eea. Endoscopic endonasal approach eea endoscopic endonasal skull base surgery has dramatically changed and expanded over recent years due to significant advancements in instrumentation, techniques, and anatomic understanding. Paolo cappabianca currently, surgical management provides the definitive treatment of choice for most pituitary adenomas, craniopharyngiomas and meningiomas of the sellar region.
Atlas of endoscopic anatomy for endonasal intracranial surgery softcover reprint of the original 1st ed. The endoscopic endonasal transsphenoidal approach is actually widely recommended for sellar lesions, even in the case of cavernous sinus invasion or suprasellar extension. The endoscopic endonasal transsphenoidal approach to the sella is performed via an anterior sphenoidotomy, through the enlargement of the natural sphenoid ostium, with a rigid diagnostic endoscope as the sole visualizing tool, and without the use of a transsphenoidal retractor. Left, lateral a and frontal c views of the surgical field during traditional transsphenoidal microsurgery with the nasal speculum. Endoscopic endonasal transsphenoidal surgery 2003rd edition. Comparative analysis of outcomes following craniotomy and expanded endoscopic endonasal transsphenoidal resection of craniopharyngioma and related tumors. In this study, consecutive patients with pituitary adenomas submitted to endoscopic endonasal pituitary surgery were evaluated regarding the rate of residual tumor. Laws and lanzino, captures all of todays clinical knowledge on the multidisciplinary management of pituitary tumors, with a focus on surgical techniques. Diagram of the endonasal endoscopic transsphenoidal approach for pituitary tumors. Endonasal endoscopic transsphenoidal approach to lesions of the sellar region in pediatric patients rucai zhan, md, phd, tao xin, md, phd,y xueen li, md, phd, weiguo li, md, phd, and xingang li, md, phd. Endonasal endoscopic surgery is one of the most common operations performed at the brain tumor center btc and pituitary disorders program at saint johns health center.
Intraoperative virtual endoscopy for image guided endonasal transsphenoidal pituitary surgery florian schulze, katja buhler, andr. However, application of eetss without sufficient experience and knowledge of the surgical anatomy may result in severe complications. We developed a series of instruments targeted to endoscopic endonasal transsphenoidal surgery. Complete with 500 fullcolor photographs, anatomic illustrations, flowcharts and tables, endonasal endoscopic surgery of skull base tumors offers a practical management approach and sets a new standard in the field. Endoscopic pituitary surgery, transsphenoidal cincinnati. Among the 10 individuals subjected to pure endoscopy.